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Prevalence of polymyalgia rheumatica in a cohort of patients with idiopathic inflammatory myopathy

  • Hannah Douglass-MolloyEmail author
  • Vidya Limaye
Brief Report

Abstract

Polymyalgia rheumatica (PMR) is a common rheumatological condition occurring in adults aged over 50 years. The association of PMR with other autoimmune diseases such as rheumatoid arthritis is complex. There is a clear relationship with giant cell arteritis. We sought to determine whether there is any association between PMR and idiopathic inflammatory myopathy (IIM). We undertook a database study of adult patients with a diagnosis of IIM under the care of the Rheumatology Department of the Royal Adelaide Hospital, and retrospectively determined the frequency of PMR in this patient cohort. Patients were considered to have PMR if this had been diagnosed by a physician or if they satisfied all five of the following clinical criteria: (1) bilateral shoulder and/or pelvic girdle aching, (2) morning stiffness exceeding 45 min, (3) age greater than 50 years, (4) duration more than 2 weeks, and (5) evidence of an elevated erythrocyte sedimentation rate or C-reactive protein. Amongst 82 patients with IIM, seven (8.5%) were found to have PMR. There was a disproportionate representation of necrotizing autoimmune myopathy (NAM) in patients with IIM/PMR (5/7) compared with patients with IIM alone (19/75), p = 0.02. There was a high prevalence of antibodies to 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) in patients with IIM/PMR (4/7, 57%) compared with those with IIM alone (9/32, 28%), p = 0.19. The prevalence of PMR in our IIM cohort was much higher than the population prevalence 0.91–1.53% and it appears there is a specific association with NAM and anti-HMGCR antibodies. Further studies are required to confirm these findings and explore mechanisms of shared disease susceptibility.

Key Points

Idiopathic inflammatory myositis, in particular, statin-associated necrotizing myositis and anti-HMG co-A reductase antibodies, may have a previously unrecognized association with polymyalgia rheumatica.

Keywords

HMGCR antibody Idiopathic inflammatory myopathy Polymyalgia rheumatica Prevalence 

Notes

Compliance with ethical standards

The study was approved by the Central Adelaide Local Health Network Human Research Ethics Committee (Reference Number R20190524).

Disclosures

None.

References

  1. 1.
    Owen CE, Buchanan RR, Hoi A (2015) Recent advances in polymyalgia rheumatica. Intern Med J 45(11):1102–1108CrossRefGoogle Scholar
  2. 2.
    Gonzalez-Gay MA, Matteson EL, Castaneda S (2017) Polymyalgia rheumatica. Lancet. 390(10103):1700–1712CrossRefGoogle Scholar
  3. 3.
    De Bandt M (2014) Current diagnosis and treatment of polymyalgia rheumatica. Joint Bone Spine 81(3):203–208CrossRefGoogle Scholar
  4. 4.
    Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, Bachta A, Dejaco C, Duftner C, Jensen HS, Duhaut P, Poór G, Kaposi NP, Mandl P, Balint PV, Schmidt Z, Iagnocco A, Nannini C, Cantini F, Macchioni P, Pipitone N, del Amo M, Espígol-Frigolé G, Cid MC, Martínez-Taboada VM, Nordborg E, Direskeneli H, Aydin SZ, Ahmed K, Hazleman B, Silverman B, Pease C, Wakefield RJ, Luqmani R, Abril A, Michet CJ, Marcus R, Gonter NJ, Maz M, Carter RE, Crowson CS, Matteson EL (2012) 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum 64(4):943–954CrossRefGoogle Scholar
  5. 5.
    Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, Miranda-Filloy JA, Gonzalez-Juanatey C, Martin J, Llorca J (2009) Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 61(10):1454–1461CrossRefGoogle Scholar
  6. 6.
    Weyand CM, Goronzy JJ (2014) Clinical practice. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med 371(1):50–57CrossRefGoogle Scholar
  7. 7.
    Crowson CS, Matteson EL, Myasoedova E, Michet CJ, Ernste FC, Warrington KJ, Davis JM 3rd, Hunder GG, Therneau TM, Gabriel SE (2011) The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 63(3):633–639CrossRefGoogle Scholar
  8. 8.
    Doran MF, Crowson CS, O'Fallon WM, Hunder GG, Gabriel SE (2002) Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. J Rheumatol 29(8):1694–1697PubMedGoogle Scholar
  9. 9.
    Yates M, Graham K, Watts RA, MacGregor AJ (2016) The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population. BMC Musculoskelet Disord 17:285CrossRefGoogle Scholar
  10. 10.
    Tieu J, Lundberg IE, Limaye V (2016) Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol 30(1):149–168CrossRefGoogle Scholar
  11. 11.
    Dalakas MC (2015) Inflammatory muscle diseases. N Engl J Med 373(4):393–394CrossRefGoogle Scholar
  12. 12.
    Pinal-Fernandez I, Casal-Dominguez M, Mammen AL (2018) Immune-mediated necrotizing myopathy. Curr Rheumatol Rep 20(4):21CrossRefGoogle Scholar
  13. 13.
    Hamann PD, Cooper RG, McHugh NJ, Chinoy H (2013) Statin-induced necrotizing myositis - a discrete autoimmune entity within the “statin-induced myopathy spectrum”. Autoimmun Rev 12(12):1177–1181CrossRefGoogle Scholar
  14. 14.
    Salvarani C, Hunder GG (1999) Musculoskeletal manifestations in a population-based cohort of patients with giant cell arteritis. Arthritis Rheum 42(6):1259–1266CrossRefGoogle Scholar
  15. 15.
    Korkmaz C, Yildiz P (2017) Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: can they be components of a single disease process in elderly patients? Eur J Rheumatol 4(2):157–160CrossRefGoogle Scholar
  16. 16.
    Gonzalez-Gay MA (2004) Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions. Semin Arthritis Rheum 33(5):289–293CrossRefGoogle Scholar
  17. 17.
    Weyand CM, Hunder NN, Hicok KC, Hunder GG, Goronzy JJ (1994) HLA-DRB1 alleles in polymyalgia rheumatica, giant cell arteritis, and rheumatoid arthritis. Arthritis Rheum 37(4):514–520CrossRefGoogle Scholar
  18. 18.
    Steel L, Bukhari M, Dasgupta B (2016) 2015 EULAR-ACR recommendations for polymyalgia rheumatica: the message and next steps. Rheumatology (Oxford) 55(6):955–956CrossRefGoogle Scholar
  19. 19.
    van Hecke O (2011) Polymyalgia rheumatica -- diagnosis and management. Aust Fam Physician 40(5):303–306PubMedGoogle Scholar
  20. 20.
    Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG (1995) Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991. Arthritis Rheum 38(3):369–373CrossRefGoogle Scholar
  21. 21.
    Hopkinson ND, Shawe DJ, Gumpel JM (1991) Polymyositis, not polymyalgia rheumatica. Ann Rheum Dis 50:321CrossRefGoogle Scholar
  22. 22.
    Gonzalez-Gay MA, Amoli MM, Garcia-Porrua C, Ollier WE (2003) Genetic markers of disease susceptibility and severity in giant cell arteritis and polymyalgia rheumatica. Semin Arthritis Rheum 33(1):38–48CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2020

Authors and Affiliations

  1. 1.Rheumatology DepartmentRoyal Adelaide HospitalAdelaideAustralia
  2. 2.Discipline of MedicineUniversity of AdelaideAdelaideAustralia

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